Transcript
Amy Barfield (00:00) good morning. Hey, good morning. Everyone in here.
Svetlana Vinokur (00:22) So, Amy Latoya is no longer with us.
Amy Barfield (00:27) Okay. I figured I got an email response yesterday. Yeah.
Svetlana Vinokur (00:34) So we disconnected her from everything. So, please make sure your team kind of knows as well that she should not be granted any access. Okay? I have quite a lot actually on the list… maybe since the email just came. So the community, this community care… for Wisconsin. So, Amy, you responded, but should we ask or do you have that email from 414 them asking questions about complex care?
Amy Barfield (01:16) That’s what I was looking at just before I got on here. I don’t let’s see… there’s one from 416. So I asked the team. I don’t see a 414 but I see a 416. So I asked the team to look… into that. What?
Svetlana Vinokur (01:39) Questions do they have? Because like I would rather address it myself if that’s kind of to move it forward because sometimes the team answers the questions that makes it even more complicated. So, do you know what they were asking?
Amy Barfield (01:54) Let’s see on floor 16?
Amy Barfield (02:02) Do you have an office in Wisconsin? Yes. Are you, they did answer it? Are you, are your providers going to nursing homes or are you doing telehealth? And we have both that’s the answer?
Svetlana Vinokur (02:18) Oh, correct. But we don’t have an office.
Amy Barfield (02:23) In Wisconsin, we.
Svetlana Vinokur (02:25) don’t have a physical office. We don’t we’re right? We operate out of the locations.
Amy Barfield (02:32) Okay. Let me respond back to him real quick.
Svetlana Vinokur (02:42) Since we see patients in nursing homes, we don’t have our own office. It was a physical location based.
Amy Barfield (02:52) Out of Michigan, right? Well, your… home office, yeah.
Svetlana Vinokur (03:10) But providers see patients in person and telehealth in nursing home facilities in Wisconsin.
Amy Barfield (03:34) I’m responding now to that one and let me do the other one is the ask the same on both groups.
Amy Barfield (04:10) Actually, the other one was.
Amy Barfield (04:18) Requesting.
Amy Barfield (04:31) working on the class… we did check a medicare letter which we gave to them on four… 13.
Amy Barfield (04:46) So, they have everything for that one. Thank you for these forms. I’ve attached your informatics. We need all areas filled out fully. It cannot say in a… but there’s no attachment hold on.
Amy Barfield (05:08) It looks like you responded back. Let me make sure it’s filled out correctly.
Amy Barfield (05:30) What does rec mean? All filters require?
Amy Barfield (05:38) Okay. Yeah. Let me flag this one. It’s just, it’s a roster and there were some… areas where they put in a… oh, wait because that’s provider information. Yeah. Let me look into that one. It’s like a roster that they’ve filled out.
Amy Barfield (06:03) You didn’t respond back yet? But in my email, I asked that they tell me if anything’s missing at this point. So in my email response.
Svetlana Vinokur (06:12) Okay. Yes. So, Amy, let’s just keep that kind of that we get that done, yes?
Amy Barfield (06:25) It sounds like they’re behind, but at least we have contact.
Svetlana Vinokur (06:31) Okay. So… healthy blue, North Carolina.
Amy Barfield (06:38) We.
Svetlana Vinokur (06:38) submitted yesterday, Amy, group enrollments and all the providers. Can you flag this to get this moving ASAP like that? That was, I don’t know why it was not requested originally. It was missed. Like when medallion did the bulk kind of group enrollments? It wasn’t it wasn’t picked up. I don’t know why.
Amy Barfield (07:06) Okay. Healthy blue, North Carolina, right? So.
Svetlana Vinokur (07:10) That’s a medicaid line. And do you know if they were able to get the rosters for just the regular blue cross blue shield? So we can know who is enrolled with what and update?
Amy Barfield (07:24) I don’t know yet. I’m going to try to get you some updates. Okay? Either by the end of the day or Monday… our team lead is out this morning. So, I’m going to connect with her this afternoon on those items.
Svetlana Vinokur (07:38) Okay. So then healthy blue of Kansas City of Kansas… Amy, like Theoria is still not enrolled as a group complex cares are done, but Theoria is still not.
Svetlana Vinokur (08:02) So, and I, and it’s on our top 15. And like I’m actually telling my team that maybe you just bill under complex care because they’re done, you know, like so, but someone needs to look at the healthy blues, healthy blue, Kansas. Like what’s going on there? Okay. Any update on our medicare appeals that we, that Nicole sent out to?
Amy Barfield (08:35) Yeah. They denied them all the names, Alexandra wright, Willie adams, and I can’t remember the third one… saying that they went as far. They’re already as far back as they’ll go on those.
Svetlana Vinokur (08:56) But that’s not true. Like the Lily adams. They didn’t even give us six CDS.
Amy Barfield (09:03) Not… Lily adams. I’ll look at them and just verify and if not, I’ll try to push or I’ll have our team push back?
Svetlana Vinokur (09:17) I have so much, I mean, like it’s… a crime to write off so much of the medicare.
Amy Barfield (09:25) Yeah. I would imagine that if updates were.
Svetlana Vinokur (09:36) And I remember Amy and Nicole and everyone was saying we’re doing medicare audit. We’re going to give you all the results of it. I have never received anything.
Amy Barfield (09:48) A medicare audit. Yeah, I.
Svetlana Vinokur (09:51) have never seen the results of it, provide a medicare audit.
Amy Barfield (10:07) Do you know when that was mentioned or?
Svetlana Vinokur (10:10) Oh, when, well, Nicole was mentioning it, probably, I don’t know like whenever Amy was actually saying that as well, right? In our complex care? Like because, I think I was bringing up this medicare write offs that we’re doing that? We shouldn’t I mean, it’s we should not be doing medicare write offs… and I have, I brought up a number of medicare for complex care people, right? That are already having issues.
Amy Barfield (10:54) Okay. I’ll look into that, see if I’ve got the results of that audit.
Svetlana Vinokur (10:59) Okay. So if I look right now at complex care, Amy, hold on, let me see. Providers. I have 23 on hold. Let’s see why they’re on hold.
Amy Barfield (11:17) For medicare?
Svetlana Vinokur (11:18) Yeah. So.
Svetlana Vinokur (11:25) I saw Troy medicare. We decided to stop it. I don’t know why is it? Okay? So, joy luck, cheese… why is she on hold?
Svetlana Vinokur (11:46) Application rejected?
Svetlana Vinokur (11:55) But the locations are done by pten. So like it’s like, I don’t understand.
Svetlana Vinokur (12:07) Okay. Please?
Amy Barfield (12:20) Thank you Michigan.
Amy Barfield (12:25) The Aurea complex?
Amy Barfield (12:34) Thank you.
Amy Barfield (12:46) We just need to add her to all the ptens.
Amy Barfield (12:53) Let me flag this. And then I can flag this.
Svetlana Vinokur (13:01) I’m going to share… entrant… mission.
Svetlana Vinokur (13:20) Joy mcleese, effective 829 here is one pten… here is a second pten here is, so there are two ptens. I said in Michigan, we only have two ptens?
Amy Barfield (13:34) Yeah, there’s only two localities, so.
Svetlana Vinokur (13:36) Then, what is, what’s not completed? If she’s already added to the two ptens?
Amy Barfield (13:44) Does she show already added to the ptens right here? So I think they’re the reason why they’re not completing is because the locations are not added. And so, if you build for it right now for those locations, they would get denied because they’re not on the group application. So that’s why it’s showing holding dependencies, even you can build.
Svetlana Vinokur (14:10) for it. So, but, okay. But if I look at my group application, I don’t have anything pending.
Amy Barfield (14:17) Okay. Or let me look at the group that’s blocking it.
Svetlana Vinokur (14:22) What’s the location?
Amy Barfield (14:25) Give me just a second and I can get it for you… locations not running out… and.
Svetlana Vinokur (14:37) Then it’s blocking all her other enrollments like that’s. Why I’m just concerned like why are we blocking all her other enrollments right now, right?
Amy Barfield (14:46) Right. Yeah, I don’t.
Amy Barfield (14:54) yeah, it says application approved. I don’t understand.
Svetlana Vinokur (15:06) So, if it’s this location that is not done, hold on.
Svetlana Vinokur (15:23) This location has been on the group level since 610, 25.
Svetlana Vinokur (15:35) If this is the, this is the only one that is missing, it’s already on the group level.
Amy Barfield (15:41) Okay. I just flagged the… team on that. Let me add it to my list so I can check up on it later.
Svetlana Vinokur (15:50) So, and everything used to be released on her. So then Marina Martin, apparently the same thing.
Svetlana Vinokur (16:00) Responded back to Klein’s desk.
Svetlana Vinokur (16:10) Oh, I don’t know what it done.
Svetlana Vinokur (16:16) Marina Martin 55 done 56 done. So, she’s also added to everything. So, I don’t know why.
Svetlana Vinokur (16:36) I don’t know why she is not done either.
Svetlana Vinokur (16:44) It’s the same location, new birth that was added. It’s it is on the group. And then.
Svetlana Vinokur (16:58) The other location is also on the group. So, I have no idea what they’re talking about. And, and because of that, right? It’s blocking, look at this, how many things it’s blocking?
Svetlana Vinokur (17:30) Oh, my God, Yolette still does not have an enrollment, how many, how much more?
Amy Barfield (17:50) Okay. I flagged medicare team to approve the group. I mean, it shows that it’s confirmed or that it’s approved. But it’s not showing a medallion and to release the providers, the provider should be linked to all ptans, which would approve their record and to release any commercial plans that are related to it that are holding dependency.
Amy Barfield (18:17) So, I’ll check back on that this afternoon to make sure those were released. Okay?
Svetlana Vinokur (18:22) But there are more, right? So, Yolette, so she is, was 70 43 58, 43 58.
Svetlana Vinokur (18:41) What is 358?
Amy Barfield (18:49) Which medicare? Is this Missouri? That’s.
Svetlana Vinokur (18:51) Illinois? Okay. What is 358? So, there are.
Amy Barfield (19:04) As of, yes, it says linking additional group ptans there’s two ptans they’re linking her to.
Amy Barfield (19:18) One ending in eight, two four, and one ending in eight two five. You share those on there for her.
Svetlana Vinokur (19:25) No, I only see the.
Amy Barfield (19:28) one I.
Svetlana Vinokur (19:29) only see a one… for her? Yeah.
Amy Barfield (19:35) So they’re linking the additional two.
Svetlana Vinokur (19:37) Okay. But, does that supposed to like block medicare aerial road medicare?
Amy Barfield (19:45) Not… well.
Amy Barfield (19:54) You get a medicare or you get a railroad for each ptan, I.
Svetlana Vinokur (19:59) believe or it?
Amy Barfield (20:01) Might just be the one I’ll have to ask. I can’t remember.
Svetlana Vinokur (20:06) Okay. So, this is unreal. I’m going to, I’m going to yell at the top of my lungs right now. So, Whitney Preston again, like I’m going to, I’m already having or having denials for her and it got rejected again yesterday.
Svetlana Vinokur (20:28) Like like this is, I.
Amy Barfield (20:46) I’m adding it to the list.
Svetlana Vinokur (20:54) I’m just tired of promises like look at this. So I have 23 people on hold here that I don’t know why is this one hold?
Svetlana Vinokur (21:20) Okay. And then I have 66 that are processing.
Svetlana Vinokur (21:31) Get that for this one?
Svetlana Vinokur (21:38) Rebecca font again?
Svetlana Vinokur (21:45) Again, rejected? Like Amy, I’m going to have, I’m going to have denials because this has been going on since… six 30.
Svetlana Vinokur (22:14) Like, I don’t know how they’re doing audits when I have all of this issues still? Like I.
Svetlana Vinokur (22:24) okay. So if we got a welcome letter?
Svetlana Vinokur (22:31) Why is this not processed correctly?
Amy Barfield (22:36) For mark Peterson? Yeah.
Svetlana Vinokur (22:37) Yeah. Look at this because they never touched it in two months in two months.
Svetlana Vinokur (22:44) They haven’t touched it. Our people attached the letter which I just left to our people Brittany, right? That Rizal, she can attach the letter, which is great. But she also needs to send an email to Amy and help, right? Yes. But that tells Amy that they haven’t touched it since February… because if they would have touched it, they would have seen that there’s a welcome letter.
Amy Barfield (23:21) The same here. Yeah.
Svetlana Vinokur (23:23) The same here. They’re not touching since February send to automation great. So, see, Rizal added all of those welcome letters and nothing has been processed.
Svetlana Vinokur (23:43) Okay. So this one says manually submitted will be reviewed on 321. Well, I’m already at 417, haven’t been reviewed.
Svetlana Vinokur (24:19) So, I think you got my point, right? Like look at this, all the welcome letters. Nothing has been updated because they haven’t touched it. Yeah, like all of this needs to be closed probably because they’re all done welcome letters. Look at this.
Amy Barfield (24:33) Are these all for railroad?
Svetlana Vinokur (24:35) Yeah. Okay. I’ll have Rizal go through those today and send them through help. No, that’s fine. Like she doesn’t break me like that’s. Fine. Like going forward, they see it, they would have touched it. They would have seen it. They just don’t touch it.
Svetlana Vinokur (24:53) Going forward, yes. Let’s make sure kind of, they do that.
Svetlana Vinokur (25:10) I see this, you’ll add. But.
Svetlana Vinokur (25:17) So, someone needs to go through this. And again, Nicole told me I have a whole team railroad that’s the only thing that they’re doing processing everything. Well. I don’t think they’ve been touching anything. What’s going on with Taryn Wilson?
Svetlana Vinokur (25:44) How is that? Let me see if this is the case actually.
Svetlana Vinokur (26:04) Well, this location, Amy is on the group level effective 625 25. I don’t know why they’re saying this location still processing under the group? How is it still processing under the group that they said in 414, when I see it black and white here that it says that it’s right in here?
Amy Barfield (26:35) Which one is this for?
Svetlana Vinokur (26:37) For midwest am Illinois?
Amy Barfield (26:44) For Terrence Wilson, yeah.
Svetlana Vinokur (26:47) But they’re claiming that it’s because of the group, but in the group, it’s right here, six three one, Lincoln highway. To me, it looks like 625 25.
Svetlana Vinokur (27:03) I don’t know what happened in Illinois, because I see like they sound like there is duplicates and one terminated one, not, I don’t know what happened here. Like look at all those duplicates… and the group.
Amy Barfield (27:23) I wonder if that was when they termed because of the eft. And then they, yeah.
Svetlana Vinokur (27:28) Maybe maybe that’s what happens, but they are active like right here. See like, right? Yeah.
Amy Barfield (27:47) Okay. So, I’m finding these right now, okay?
Svetlana Vinokur (27:53) They give me Rebecca font, and Preston, I want to, I want to go with that on the record. If we ever have a write offs related to that. It’s on medallion. Okay. If… that.
Amy Barfield (28:13) Happens that’ll be a conversation you’ll have to have with Mitch because I don’t have any control over that, but I’m hearing you. I understand. Okay?
Svetlana Vinokur (28:24) I’ll send an email to Mitch and Derek and on those two.
Amy Barfield (28:33) Back on this row of things.
Svetlana Vinokur (28:39) Okay. I want to talk to you about medicaid Georgia. But maybe like when at the end of this call that it’s just between you and me. Okay. Blue cross blue shield of Michigan. I’m seeing a lot of kind of, I have seen some movement. I’m really confused kind of they, they’re saying that providers enroll but the group is not, can we please have a call with the person who understands and deals with the blue cross blue shield of Michigan to go through our providers that are being rejected on our whole list to really understand what are they enrolled with? What are they not enrolled with? And why we are rejected when, and what are we seeing? Because, I feel like it’s like broken telephone. We are playing… working session with Lori and Carrie and the person from your team who is responsible and they’re going to go through that list of my credit holds with the oreo.
Amy Barfield (30:03) Okay. Nicole is back. She’s out of office right now. She’ll be back on Tuesday, so I can ask her if we can set up a call. Okay?
Svetlana Vinokur (30:22) So, Aetna better health. I talked to Janelle today. I’m going to work with her directly on the complex… cares. If there’s an Aetna better health complex, Ellen white complex care enrollment, you can make them client owned.
Amy Barfield (30:46) Just for the group or all the providers as well?
Svetlana Vinokur (30:49) For all the providers as well because we’re just going to provide rosters.
Svetlana Vinokur (30:58) But just a little,
Amy Barfield (30:59) health all complex, both complex cares in Illinois. Yeah.
Svetlana Vinokur (31:04) So, let me see if.
Svetlana Vinokur (31:29) And, and by the way, Amy, like yesterday, I was myself doing the group in the group and providing enrollment for healthy blue, North Carolina. And I’ll tell you this system is so not user friendly. It took 30 minutes to get it done. It was horrible. Our.
Amy Barfield (31:50) System are healthy. Yeah, yeah.
Svetlana Vinokur (31:52) No, like just for me to put the enrollment in just the way the locations and how kind of it’s asked. It. Just, it’s just horrible. So I need to talk to the next time we’ll talk to, the team? I want them to go through kind of and see how painful it is and how bad it is. Okay?
Amy Barfield (32:15) Do you want me to set up like an ad hoc meeting because we don’t have one for another, like.
Svetlana Vinokur (32:20) Yeah, maybe kind of because, I think like, and maybe like what we’re doing with facilities will help some of that. But just one example, right? That I clicked, yes, I want all the facilities for all the providers. I probably were adding like 20 providers, right? And in pool the facilities and one of the facilities was termed. So then I had to go and manually remove that facility from every single provider, scrolling down looking for that kind of like and manually click X on all. Like, I mean, it’s so cumbersome, right? And, and it,
Carrie Reding (33:01) pulls providers, which is nice, but it doesn’t pull groups, which I always thought was weird. So, like if you’re looking for the locations underneath there, you have to manually add and click each group location. So.
Svetlana Vinokur (33:16) It just was, I mean, it literally took me 30 minutes to do one, one group enrollment with the providers.
Amy Barfield (33:27) Okay. I’ll reach out to them and we’ll try to set something up.
Svetlana Vinokur (33:31) Okay. I don’t even see it in the better health. How is it? Because maybe it’s well done?
Svetlana Vinokur (33:46) Okay. So, I see for Aetna, better health only.
Svetlana Vinokur (33:59) There is one for M, and one for H. You already made that client owned? Okay. So.
Amy Barfield (34:08) We’re good. Yeah.
Svetlana Vinokur (34:10) Yeah. I already made that. Okay?
Svetlana Vinokur (34:23) Yeah. Carrie, what did we were looking yesterday? That the provi, I sent you a link. I think I sent you an email. I think in me yesterday… that was a healthy advantage that providers are still medallion owned?
Svetlana Vinokur (34:45) I think that, that’s what it was.
Amy Barfield (34:53) Where’s Caroline… health team advantage? Yeah.
Svetlana Vinokur (34:59) Health team. Yeah, there was.
Carrie Reding (35:03) Like four providers, I think, and I updated the roster on my end because I think that was part of the issue. So.
Svetlana Vinokur (35:11) So, health team, yeah, health. Okay. Health team advantage, right? So the, I made them. So this one is, yeah, see, I loaded, the contracts and then there was another one, so.
Amy Barfield (35:31) You just need those client owned?
Svetlana Vinokur (35:33) Well, so they already done, so this one was client owned. So I also added it. All right. But the providers, we can’t update providers that are enrolled because it’s all says it’s all medallion… right? So we,
Amy Barfield (35:53) just need to flip the providers to client owned.
Svetlana Vinokur (35:56) Yeah, we either need to clip the providers or you guys need to update. Yeah, because see it says medallion owned. Yeah.
Svetlana Vinokur (36:10) We have a roster, right? To carry that. Yeah, we sent it to them and they updated. But… so that needs to be updated because the team is enrolled, effective for one with the, with all the providers. I,
Amy Barfield (36:26) can I can do either, but, if you want us to complete it, I’ll need that roster, right?
Svetlana Vinokur (36:31) So, we’ll send you the roster? Okay?
Carrie Reding (36:33) I’m sending it right now, I’m downloading it.
Svetlana Vinokur (36:40) And then priority health, Amy, like have they started on that? I haven’t seen?
Amy Barfield (36:51) You still haven’t seen that? Okay?
Svetlana Vinokur (37:06) No, right now, everything is on hold. Yeah, everything is still on hold.
Amy Barfield (37:27) I’ve got today too.
Svetlana Vinokur (37:31) So, I… want to see what happens with this Chidi. So Massachusetts medicaid, we… have two providers that we were having issues with.
Svetlana Vinokur (37:58) So, so I need to understand what’s happening with this Chidi… because she is, I think in the system maybe… pending. She also, it says that she has the ability… to write prescription, order something but not seeing patients.
Amy Barfield (38:22) Oh, she’s not a fee for service provider? Yeah.
Svetlana Vinokur (38:26) So, can we figure out what’s happening with Chidi on the medicaid?
Carrie Reding (38:33) Are those enrolled, Amy as a fee for service group?
Amy Barfield (38:41) So, for Massachusetts medicaid, if you’re if you have a facility contract, then they’re billed under the group and the providers can be orp, or ffs, but if it’s a group enrollment, which is what I believe you guys have, they have to be fee for service, yeah.
Svetlana Vinokur (38:59) Okay. Yeah. So.
Amy Barfield (39:00) I just have to make sure they’re enrolling her as fee for service.
Svetlana Vinokur (39:03) And we really don’t need medicaid Theoria, right? Because as a four one, we transition to complex care anyway.
Amy Barfield (39:11) Okay. Do you want me to stop the one for Theoria? Well?
Svetlana Vinokur (39:16) It needs, yeah, there is need there’s like the complex care. The mid was, M, is the one that we need to kind of make sure is.
Amy Barfield (39:26) Okay. So, stop Theoria for Chidi. Yeah.
Svetlana Vinokur (39:30) We don’t need to follow up on Theoria because they actually transitioned all the providers and everything to complex care effective for one, but she was not on the list.
Amy Barfield (39:42) Oh, gotcha. Okay. And,
Svetlana Vinokur (39:44) then what’s the other one? OB?
Carrie Reding (39:51) Olam?
Svetlana Vinokur (39:53) Olam, or L?
Carrie Reding (39:55) Ola… yeah.
Svetlana Vinokur (40:00) So, she is Amy, the one that was… not enrolled at all. And Latoya completely submitted completely wrong application. I mean, like completely wrong. It was complex care. I mean, it was M, it was dr, Drew packy. Like it was just completely wrong. Looks like it has never even been in medallion. It had been kind of. So I guess we’ll just deal with it directly and I reached out to the Bernadette woman to ask her, like should we just redo it? So she.
Carrie Reding (40:41) responded and said we need to redo it. So.
Svetlana Vinokur (40:44) Okay. So Kerry, let’s just work today to redo it. Yeah. So we’ll just.
Carrie Reding (40:48) I’ve already requested the application so, cause you have to request it by email.
Amy Barfield (40:52) Okay. So I don’t need to do anything there, no.
Svetlana Vinokur (40:54) You don’t need to, but if you can, we can check on this chatty, that would be. Okay. Yeah, I can do that. Okay. So on the Illinois, meridian, Illinois and,
Svetlana Vinokur (41:15) and Aetna better health, Illinois… we are working directly kind of, with the people.
Svetlana Vinokur (41:28) To get us enrolled, right?
Amy Barfield (41:30) And those providers and groups should be quite owned.
Svetlana Vinokur (41:33) Right. Because we’re just going to provide them the rosters.
Svetlana Vinokur (41:43) So, and then, Amy, I have not seen any movement in Kansas, blue cross, blue shield, Kansas, blue cross, blue shield of Wisconsin.
Amy Barfield (41:57) For all entities, yep.
Svetlana Vinokur (42:09) Okay. So… that’s it on my list. But other than Georgia, I want to talk to you one on one.
Brittany Dees (42:24) Okay. I just have a couple things really quick. So I’m, noticing that medallion is not adding the revalidation dates in there. And, or if they are, they’re adding some sort of, you know, another date and what’s happening is I’m pulling a report from medallion to start completing the revalidations. And so, I, would, I, before I even receive any sort of notice, I’m going off of this list that I’m pulling from medallion and requesting for revalidations to be completed, medallion is starting to push back on those and give us tasks and let us, you know, tell us that we cannot complete a revalidation because you guys have, we don’t have the notice or this date is not correct? So, can we, what can we do to facilitate like to get, have those correct dates put in? So when I am pulling those, when my team’s pulling those reports, we’re submitting the correct revalidations.
Amy Barfield (43:26) Can you send me some examples of where they’re tasking you? So I know what kind of correction I need to make on my end?
Svetlana Vinokur (43:37) Yeah. So Amy and I just closed the test today on the revalidation they want locations. Well, it has nothing to do with locations. Oh, and then they wanted the legal entity. Well, it’s also, it has nothing to do with legal entity. It has to do with the provider, right? So I think they do not understand what revalidation actually means.
Amy Barfield (44:05) Yeah. Is that coming from like the provider enrollment side or intake side?
Svetlana Vinokur (44:12) I don’t know. I think, I mean, it’s on the.
Amy Barfield (44:14) Tab, yeah, just give me the examples and I’ll look and I’ll see because I’ll need to know like where to make it. Hold on let.
Svetlana Vinokur (44:19) Me just, I just closed one just today. Let’s see if it’s going to pull completed so I can show you or if it’s overloads.
Brittany Dees (44:28) Okay. Yeah. Well, that’s loading really quick. Another thing is I’ve received over 30 emails this morning from healthsmart solutions and every single email they’re requesting for a copy of the Dea or a copy of their board cert, is medallion, sending those in with the application.
Amy Barfield (44:54) Board certifications. And what was the other one?
Brittany Dees (44:57) A Dea?
Brittany Dees (45:03) Yeah. So I’m sending all of those, the copies in, but it just seemed it’s the same. It’s the same question. Can copy of the Ea, copy of wallet cards for board cert wallet?
Amy Barfield (45:17) Cards, license, you mean?
Brittany Dees (45:19) No wallet card? Is the board, sir? Okay?
Amy Barfield (45:29) I’ll look into those and look at their project plan and make sure that that’s in there as well. Okay?
Svetlana Vinokur (45:37) Right here. Let me show you if you see. So, can you show a list of location that we can proceed with the revalidation?
Amy Barfield (45:49) Hold on, don’t move. I’m going to screenshot this?
Svetlana Vinokur (45:58) Okay. And… then there was another one. See there are a bunch of them kind of.
Brittany Dees (46:15) Yeah. This is one of those with the revalidation letters. I’m not receiving. I’m not waiting to receive the revalidation letters to submit revalidations. I’m pulling a report specifically based from medallion and submitting those revalidations, right?
Lori Durkin (46:31) Could I suggest that we maybe off that report? I just dropped a link here in slack. CMS puts out a file every month of providers that are potentially due for reval, and if they’re due, they’ll put a due date in there. Would that be helpful? You can look them up individually as well? But this link I just gave is like an actual monthly list. And then there’s another spot I’ll drop that you can like just search by each individual provider. Yeah, I.
Brittany Dees (47:04) mean, I mean, that this is great. Yeah, we.
Svetlana Vinokur (47:08) just need to fix it kind of right, in medallion. So then we don’t know, I mean, right, right.
Lori Durkin (47:14) Yeah, and could go there and look, you know?
Svetlana Vinokur (47:17) Like, so we just need maybe like any like demons to update like… based on with the pool. I guess, I don’t know. But yeah, there has been a lot of revalidations tasks on the locations here’s. Another one, right?
Svetlana Vinokur (47:43) Brittany.
Amy Barfield (47:45) do you know that you said you sent it to support and they’re pushing back, no?
Brittany Dees (47:50) I, I’m just completing the task out. So like one.
Svetlana Vinokur (47:53) Of them, yeah, the tasks, right? Like here, the tasks?
Brittany Dees (47:55) Just tasks. Yeah, one of them was Alan Stewart that recently that we Carrie and I were dealing with because I submitted a revalidation based on the report that I’m pulling from medallion saying send me the letter because this, how do you know, this revalidation needs to be done? I’m like, well, this is based on your date that you’re putting in medallion. I’m pulling from parent.
Amy Barfield (48:20) You.
Brittany Dees (48:20) know, so that’s how, you know, and they’re like, well, you there where’s the letter, we need the letter. And so, I think that like going forward, we just need to have and ensure that once enrollments are completed, we need to have medallion entering the correct dates in, you know, where in the revalidation spot. So when I pull the report, I don’t need to wait on a letter we have, you know?
Svetlana Vinokur (48:43) Yeah.
Amy Barfield (48:44) I think so.
Svetlana Vinokur (48:46) Something here is a lot of those historically because letters get lost in the mail or, whatever they.
Brittany Dees (48:53) Go to their previous employers. The biggest issue that’s that we have.
Amy Barfield (48:58) Yeah. I think… some require a letter because they give you some kind of code or whatever to do the revalidation. But I think what they should have done rather than task you is to call the payer and say, are they due for revalidation if it’s changed what’s the new date? Yes. And then if a letter was issued, can you send me a copy of that letter? Because they’re not at whatever address you sent it to you?
Brittany Dees (49:22) Know.
Amy Barfield (49:23) Yeah.
Brittany Dees (49:24) Yeah, that, and I think I completely lost my train of thought. Sorry, no, you’re good. I’m sorry?
Amy Barfield (49:35) Well,
Carrie Reding (49:36) when you put in the revalidation, there’s a spot in there that asks you if you have the attachment and if you put no, that’s when they should be triggered to call in the first place, because obviously, we don’t have anything but, you know, because sometimes we just get an email from the provider, you know, or we get something from the facility going, hey, this provider’s not going.
Amy Barfield (49:58) Through, oh, I.
Brittany Dees (49:59) Remembered what I was going to ask when we complete demo updates. So once we do a demo update, they have, you know, their original enrollment and revalidation date, when a demo update is done, is there a different revalidation date? Because I’m kind of seeing that a little bit as well. So, and if that’s the case, then medallion needs, after the demo update, medallion needs to go and update that revalidate as well. Yeah, the.
Amy Barfield (50:26) Revalidate is based on initial credentialing. So, when they were first enrolled, so, if a demographic is done, it’s just an update to its current status. So it doesn’t change the revalidate. Okay? So, even if they were employed somewhere else and they were active in another employer, and then they came and did.
Svetlana Vinokur (50:49) A demo?
Amy Barfield (50:50) Or initial enrollment with your group, the original revalidate would be their revalidate, that’s why? Sometimes you see, hey, we just got them enrolled three months ago. Why are they all of a sudden up for revalidation because their initial enrollment was three years prior. Okay?
Brittany Dees (51:06) Okay. Yeah. That makes sense. Okay. So, yeah, because sometimes I see a demo update and once the demo update is completed, they’ll have another revalidation date in there. So.
Amy Barfield (51:15) Oh, like it changed.
Brittany Dees (51:17) Like it changed. Yes, like it like updated. Yeah, medallion will have that in there medallion, you know, how in their notes section? Yeah. So like it updated. So just wanted to confirm on that, but if we can just get a better process on the medallion side, so I’m not waiting for letters, I can just go ahead and have my team just start submitting based on those specific dates and we can just do that with complex care. And so we don’t have, you know, going like starting now with complex care. So we don’t have any issues going forward?
Amy Barfield (51:46) Sure. Yeah, I’ll have that conversation with them. Okay?
Brittany Dees (51:49) Thank you.
Amy Barfield (51:52) Anything else from anyone else? Do we?
Carrie Reding (51:55) Have any news or updates on blue cross blue shield Illinois? I’m getting asked like daily. Yeah, yeah.
Svetlana Vinokur (52:03) It is becoming like a big issue for us. Yeah.
Carrie Reding (52:08) Stanley Islam, sarpong, now, fregani, all of those providers, I mean, we just like I… said, we’re redoing their applications but I’m not seeing a whole lot of movement, so.
Amy Barfield (52:25) And this is for Theoria.
Carrie Reding (52:31) Yes, yes, it is.
Carrie Reding (52:39) And I still don’t know why I think I asked the other day what happened with Islam’s because they stopped it or it got rejected and it’s having to be redone again?
Amy Barfield (52:56) Yes, I haven’t so.
Svetlana Vinokur (52:58) Like we need to like the doctor who has right now, blue cross blue shield needs to go okay, like for more compliance reasons, but we cannot let him go because we don’t have another provider that can act in that capacity because we don’t have blue cross blue shield. So we are running the compliance risk here. Okay?
Carrie Reding (53:30) Because they resubmitted it on the tenth… but I just, I don’t know, I think I just did blue cross just kick it out? Was we missing information out of it? I?
Amy Barfield (53:43) Don’t know. Okay, I did flag Islam and haji those were two that you had mentioned… and Matthews, and,
Carrie Reding (53:55) Matthews, serpong, and fergani, I think are all of them the most of them, yeah. And,
Amy Barfield (54:02) I will see if they have an update for me and provide that to you or you and so on. Okay?
Amy Barfield (54:16) Okay. Any other questions?
Svetlana Vinokur (54:22) Okay. So, maybe then, Amy, you and I can, I,
Carrie Reding (54:25) do? Okay. So, with medicare, I’m assuming those need to go back to our old process… of getting this, what’s the question, getting the, for the medicare surrogacies, we… with Latoya gone, I think those have to you guys in order to access that you guys have to have it through this first layer, AI, correct? Gary?
Svetlana Vinokur (54:57) We are going to continue doing medicare like what’s the, what’s? Yeah. Okay.
Carrie Reding (55:02) Never mind. Okay. All right. I.
Amy Barfield (55:04) Do have a hard stop at 10 30. So, do you want to take the rest of the time? Svetlana? Yes.
Svetlana Vinokur (55:10) Okay. Did you read the, my exchange, with Derek?
Amy Barfield (55:16) And you?
Svetlana Vinokur (55:17) Can drop off, are we off? Okay. Yeah, have a good day. Okay? Thank you. Bye. Do you need me? Okay? No, I can handle it.
Amy Barfield (55:28) Let me see if I can find it here.
Amy Barfield (55:46) I’m trying to see where we’re at here.
Svetlana Vinokur (55:53) So, the summary is that someone is feeding Derek incorrect information and.
Svetlana Vinokur (56:03) If I were a CEO, I would be very embarrassed.
Svetlana Vinokur (56:10) And he finally just said he’s sending it to you.
Amy Barfield (56:14) Okay. Yeah. So I know that there’s.
Amy Barfield (56:26) two different stories here. I know we got the letter was dated on eight one. We received at 829. The request is after that, I, we made a request for retro, but the retro was more than six months. I believe I’ll have to look back. And that’s why it was denied. So when we went back to do another submission, no.
Svetlana Vinokur (56:54) No, we need to get the facts straight, right? And that’s what’s really kind of upsetting me, kind of that medallion is not having facts, straight, right? And kind of right? So, the application, the original application was approved as of seven one effective day. The letter was sent on eight one, right? The letter was dated eight one. Okay. So, and our people loaded that into the system. And because medallion doesn’t check stuff periodically anyway. So, on 912 medallion finally marked it as enrolled, complete, right? So, the medicaid, Georgia rules say that you have two months from the day of your welcome letter to… ask for the appeal, welcome letter was dated nine one eight one.
Svetlana Vinokur (57:57) So 60 days, 10 one, right? Okay. Are you good with me on the facts so far?
Amy Barfield (58:05) Okay.
Svetlana Vinokur (58:06) So, right in here… on… 912… the request was sent to add retros, right? And presumably on 925, that’s what you guys did… 925 is before 10 one, right? So it was submitted presumably in time. Okay? So then when… medallion is telling us that we submitted it incorrectly and we did not submit it in time, this factually is not right?
Amy Barfield (59:00) Okay. So it was submitted on time and we submitted it within timeline. Okay.
Svetlana Vinokur (59:08) So, then you need to have, you should have ability to go back to… Georgia medicaid and prove them that we submitted it timely. What happened is… I don’t know kind of what happened. But if you submitted retros or whatever, you closed this task, right? And we still got denials and that’s why we were told to open a new one.
Svetlana Vinokur (59:44) And that’s why do we open it again on 12 30? So it’s not that we ask for that for 12 30. We asked for it on 912. Okay. And… and that’s been like that with every single Georgia provider, if you go to every single Georgia provider we requested, timely?
Amy Barfield (60:10) Are you seeing that we’re not submitting timely on?
Svetlana Vinokur (60:13) Each, I don’t know kind of because I don’t have an ability to look at it and say, what did you actually submit it on 925? Amy, right? I don’t see. They, I don’t know.
Amy Barfield (60:28) What was actually it has to be submitted on the portal. So there’s not like a form or anything it has to be submitted.
Svetlana Vinokur (60:34) Okay. Well, then someone needs to go kind of right and see what was actually submitted because my whole point is medallion is coming back right now to us and saying that we did not do any, something timely. And my answer back to medallion that we did, right?
Amy Barfield (60:54) It sounds like we both did what we were supposed to do, but medicaid is not accepting it. So.
Svetlana Vinokur (61:00) But that’s that then if that’s the case, then, did we outlined and showed to them that we actually did what they asked to do, right? And I’m not sure that was done, yes.
Amy Barfield (61:12) I had the, I had Amanda, I don’t know if you’ve met her, she’s been on some of our other calls with the other girls, but, she was digging into this deeper. And because I specifically asked her, I said there was an original request sent. They should have approved it. And she’s saying they will not go back. They won’t adjust any other. They won’t adjust, the request. They won’t give all these things even if we submit something, they’re not going to approve it because it’s outside. So they’re like standing their ground that they won’t.
Svetlana Vinokur (61:47) But did we show them the facts? And that’s what? Because I think medallion didn’t have their facts, right? Because if you read the emails from Derek, which clearly came from someone, they didn’t have the facts, right?
Amy Barfield (62:04) I will share this conversation with our PE team and see if we can dig a little bit deeper and push on that original request.
Svetlana Vinokur (62:13) So, because medallion, like if I look at Derek’s.
Svetlana Vinokur (62:24) and Amy, that’s what it upsets me because you work with me long enough to know that.
Amy Barfield (62:29) Like if I,
Svetlana Vinokur (62:32) go like I check my facts first before I go and very rarely kind of, I, you know. So, so he’s claiming that it’s… 60 days from seven, one effective day, which is not true. It’s 60 day from a welcome letter, not the effective date. So, and,
Amy Barfield (62:58) I did get conflicting information from our PE team. One said effective date one said from letter. We did clarify it from letters because effective.
Svetlana Vinokur (63:07) Date can be anything kind of right? We, we cannot ask for the retros, and then you see like it’s I actually hold on. I actually checked gpt it and I here it says from approval welcome letter.
Amy Barfield (63:29) Yes, we verified that as well, right?
Svetlana Vinokur (63:31) So, so then, you know, then this whole box and all of this kind of right? Like which is doesn’t matter. It’s irrelevant kind of, because, if medallion submitted everything on 925, we were within the time frame. Okay? So, the question is, what did medallion submit it to medicaid on 925?
Amy Barfield (64:03) Okay. Will find out for you, okay? But,
Svetlana Vinokur (64:08) but I have 100 grand of this kind of stuff, right? I think so. Okay.
Amy Barfield (64:16) I do have to hop five minutes, right? Two minutes. Thank you. Bye bye.